Pediatric Coding Alert

Not using 24640 -- a common error -- can cost your practice almost $70.

You'll have an easier time landing on the precise code for a radial head subluxation or an apparent life-threatening event (ALTE) when ICD-9 2010 introduces specific codes for these injuries.

Clearly Describe Subluxation Using Specific Code

ICD-9 2010 adds a specific code for ursemaid's elbow"": 832.2. ""The new code offers a much better fit to describe what the physician has really diagnosed "" says Lynn A. Brown CPC director of physician coding and reimbursement at Children's Health System in Birmingham Ala. Code 832.2 will better show payers the service's complexity.

You currently have to lump the elbow dislocation as occurring at an unspecified site: 832.00 (Dislocation of elbow; closed dislocation; elbow unspecified). If you look up the term ""nursemaid's elbow"" in the ICD-9-CM 2009 index it directs you to 832.0x Brown points out.

Catch: The ICD-9 2009 code forces the coder to figure out which fifth digit to apply. Since nursemaid's elbow is a subluxation of the radial head category 832's specific location fifth-digit subclassifications do not apply Brown says. Therefore you have to use the unspecified digit of ""0.""

Switch From 5- to 4-Digit Code

When the 2010 ICD-9 codes become effective you can bid nursemaid elbow's fifth-digit mystery step good-bye. Looking up the term in the ICD-9-CM 2010 index will direct you to the complete code: 832.2.

Pay attention: You'll need only four digits. The fifth-digit subclassifications for the other 832 category codes under category 832 are not applicable for this new code according to the ICD-9-CM Coordination and Maintenance Committee.

Don't Miss 24640's Revenue

Not using 24640 can cost you almost $70* based on current Medicare equivalentpayments. Pediatricians often forget to properly report their radial head subluxation reduction effort with the procedure code (24640 Closed treatment of radial head subluxation in child nursemaid elbow with reduction). ""They put the work in an E/M code instead "" Brown notes.

Loss: The visit would have to qualify as 99204 (3.93 relative value units [RVUs]) or 99215 (3.46 RVUs) to pay more than 24640 (2.89 RVUs). If the pediatrician circled 99212 (1.03 RVUs) for performing and documenting a medically necessary problem-oriented history and examination with straightforward medical decision making the practice would lose $67. In the office 24640 pays approximately $104 compared to 99212's rate of approximately $37.

*Figures based on the 2009 Medicare Physician Fee Schedule which you can use to gauge private payers' rates.

Explain Tricky ALTE Diagnosis With 799.82

Struggling with what diagnosis to use when you treat an infant who has suddenly turned blue at home then appears normal at your office or in the emergency department (ED)? Finding an applicable code for a patient who has a severe transient event has always been difficult in the past says Richard Tuck MD FAAP pediatrician at PrimeCare of Southeastern Ohio in Zanesville. The important creation of 799.82 (Apparent life threatening event in infant) is going to help pediatricians code for a scenario that occasionally occurs.

You'll now be able to report ALTE which will allow capturing statistics on this condition. ""To date all determinations of incidence have been based on surrogate diagnoses (e.g. cyanosis apnea) "" reports Jeffrey F.Linzer Sr. MD MICP FAAP FACEP who was instrumental in getting the new code approved.

Count These Cases as ALTE

Check out these instances of when 799.82 could apply.""Examples would include apparent or actual apnea with or without cyanosis; a limp unresponsive infant; or a child gagging on food or phlegm and having a period of cyanosis or unresponsiveness "" says Linzer who is the associate medical director of compliance and business affairs for the Emergency Pediatric Group at Children's Healthcare of Atlanta at Egleston. About half of the children will have a normal exam.

Beware of Typical POS Misleading Terms

Expect to use 799.82 mainly in place of service 23 (Emergency room hospital) but don't rule out using it in POS 11 (Office). While some of these children may show up at a primary care office the majority will come to the ED Linzer says.

Don't mistake ALTE with ""near-miss SIDS"" or ""aborted crib death."" You should abandon such previously used terminology which misleadingly implies a possibly close association between this type of spell and SIDS. ""While about 5 percent of children who have an ALTE will die from SIDS there is no causal relationship between the two "" explains Linzer.

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